National Disability Services Submission: NDIS market concerns

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National Disability Services Submission:

Joint Standing Committee

National Disability Insurance Scheme

(NDIS) General Issues Inquiry

National Disability Services 1

About National Disability Services

National Disability Services (NDS) is Australia’s peak body for disability service

organisations, representing more than 1000 service providers. Collectively, NDS

members operate several thousand services for Australians with all types of disability.

NDS provides information and networking opportunities to its members and policy

advice to State, Territory and Commonwealth governments. We have a diverse and

vibrant membership, comprised of small, medium and larger service providers,

employing 100,000 staff to provide support to half a million of people with disability.

NDS is committed to improving the disability service system to ensure it better supports

people with disability, their families and carers, and contributes to building a more

inclusive community.

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Contents

About National Disability Services ………………………………………………………………………. 2

Contents …………………………………………………………………………………………………………. 3

1.0 Overview …………………………………………………………………………………………………… 4

2.0 Scope of submission …………………………………………………………………………………… 4

3.0 State of the disability sector …………………………………………………………………………. 5

4.0 Workforce Census ………………………………………………………………………………………. 7

5.0 The importance of market stewardship in the NDIS …………………………………………. 8

The crucial role of NDIA market stewardship in the NDIS ……………………………………. 8

Conflict of Interest: Setting fair prices while containing Scheme costs …………………. 11

Business dynamism: A sign of a healthy market? …………………………………………….. 12

6.0 Strategic pricing for a sustainable NDIS ……………………………………………………….. 13

Pricing and its impact on the market ………………………………………………………………. 14

2023–24 Annual Pricing Review ……………………………………………………………………. 14

7.0 Recommendations for a better NDIS market Stewardship ……………………………… 21

The NDIS Review: A call for reform ……………………………………………………………….. 21

The way forward ……………………………………………………………………………………. 23

Pricing reform: Ensuring transparency and sustainability .................................     23

Workforce investment: Fostering a skilled workforce .................................            26

Strengthening market monitoring and intervention for NDIS sustainability ............ 26

8.0 Conclusion ………………………………………………………………………………………………. 28

Contact …………………………………………………………………………………………………………. 29

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1.0 Overview

National Disability Services (NDS) welcomes the opportunity to make a submission to

the Joint Standing Committee on the National Disability Insurance Scheme (NDIS)

General Issues Inquiry.

The NDS Submission is in response to the Committee’s request for information on the

implementation, performance, governance, administration and expenditure of the NDIS.

2.0 Scope of submission

The National Disability Insurance Scheme (NDIS) has established a market for

disability supports. However, this market remains in its formative stages and faces

significant challenges. This submission focuses on the critical role of the National

Disability Insurance Agency (NDIA) in stewarding this market and ensuring it delivers

on the core objectives of the NDIS. We argue that a shift in perspective is necessary,

moving away from a purely transactional “market” language and towards a focus on

“community development” within the NDIS ecosystem. This approach emphasises

collaboration, sustainability and participant empowerment.

We make a number of practical recommendations that would improve the way in which

the NDIS market operates and better align incentives for participants, workers,

providers and government.

Recommendations

More detail on each of these recommendations is provided in Section Seven.

  • Establish an Independent Pricing Authority in alignment with NDIS Review findings.

  • Implement a cost-reflective pricing model within the new NDIS pricing and payments framework (as outlined in Action 11.1 of the NDIS Review).

  • Implement a registration supplement for NDIS Providers.

  • Fund strategic workforce development and retention.

  • Establish a sector-led reform implementation taskforce.

  • Develop a collaborative five-year NDIS implementation roadmap.

  • Create an industry transformation fund.

  • Develop a comprehensive implementation plan for a risk-proportionate regulatory framework.

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  • Enhance initiatives to empower participants.

3.0 State of the disability sector

The NDS 2023 State of the Disability Sector annual survey and report, in collaboration

with the Centre for Disability Research and Policy at the University of Sydney, sheds

light on the challenges faced by disability providers. The findings depict a sector

teetering on the brink.

The report found:

  • 72 per cent of not-for-profit providers and 67 per cent of for-profit providers are

    worried that they will not be able to provide NDIS services at current prices.

  • 34 per cent of providers made a loss in FY 2022-23; 18 per cent broke even.

  • 82 per cent of respondents received requests for services that they could not

    fulfil.
    
  • 78 per cent reported extreme to moderate difficulty finding support workers, with

    availability of allied health professionals ranging from low to non-existent.

As the provider sector responds to the Royal Commission into Violence, Abuse,

Neglect and Exploitation of People with Disability (the Royal Commission) and NDIS

Review recommendations, the State of the Disability Sector Report point to the urgency

and significance of addressing the issues in ways that foster and build a sustainable

sector for people with disability.

Organisation finances and general operating environment

In the last three surveys, between 19 and 23 per cent of providers reported a loss. This

year, a concerning 34 per cent of providers reported a loss and just 18 per cent broke

even. This is the worst year for financial viability in the history of the survey.

Opinions about general operating conditions remain poor, with 70 per cent saying that

they have worsened in the last 12 months. When asked about the wider Australian

economy, 68 per cent say that conditions have worsened.

This underscores the challenging financial situation faced by many disability providers,

with organisations having to make tough decisions about whether they can continue

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offering services, emphasising the need for strategic interventions to ensure the

sustainability and financial well-being of service providers in the disability sector.

Most providers would place the root of this problem in pricing, especially with the rising

cost of doing business. Seventy-two per cent of not-for-profit providers and 67 per cent

of for-profit providers said they worry that they will not be able to provide NDIS services

at current prices.

Yet demand for services keeps rising. Eighty-two per cent of respondents said they had

received requests for services that they could not fulfil. The reasons they gave for

turning down services include having not enough staff (45 per cent), not enough

qualified staff (21 per cent) or not enough organisational resources or money (15 per

cent).

Quality and safeguards

Perceptions of the NDIS Quality and Safeguards Commission (NDIS Commission)

continue to lean towards the negative. Fifty per cent of respondents express

dissatisfaction with its collaboration with providers. Positive sentiments towards the

NDIS Quality and Safeguarding Framework declined in 2023, with a notable increase in

respondents (48 per cent in 2023 compared to 41 per cent in 2022) disagreeing with

the statement, “We are confident that the NDIS Quality and Safeguarding Framework

supports the quality of services/outcomes.“

Half the respondents acknowledge positive outcomes from the Commission practice

guides, while only 47 per cent believe that the behaviour support requirements to

reduce and eliminate restrictive practices are yielding favourable results.

National Disability Insurance Scheme registration

Nearly 18 per cent of respondents are considering dropping their registration with the

NDIS Commission. Services established during or after 2014 are significantly more

likely (26 per cent) to consider dropping their registration, almost double the rate for

organisations established before 2014 (14 per cent). Additionally, smaller organisations,

both in terms of headcount and turnover, and for-profit entities show a higher likelihood

of considering deregistration compared to their counterparts.

Respondents express concerns about the administrative burden, costs, lack of benefits

in registration and the perceived lack of accountability for unregistered providers. These

findings are underscored by concerns with a perceived two-tier service provider market,

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with, on the one hand, registered providers shouldering the costs and administrative

burden of registration and, on the other, unregistered providers delivering many of the

same services but with less oversight and accountability.

Recommendations from the Royal Commission and NDIS Review and, more recently,

the NDIS Provider and Worker Registration Taskforce to simplify registration should be

a priority. Notably, 77 per cent of respondents find that, collectively, NDIS pricing and

regulation hinder the provision of innovative services responsive to participant needs, a

sentiment consistent with previous years. Concerns around the regulatory environment

and quality and safeguarding framework need to be addressed urgently and carefully.

4.0 Workforce Census

NDS’s latest annual Workforce Census Report, shows that, having stabilised in 2022,

the sector’s workforce recruitment and retention problems have not eased. Providers

face serious workforce pressures as they enter a long period of NDIS reform.

The NDS Workforce Census 2024 received responses from 361 organisations

representing 67,363 disability support employees across Australia. This was the second

highest response rate in the history of the survey, due strong interest from NDS

members and the sector.

The 2024 results mostly show a continuation of previous workforce trends, but in this

case, consistency is not a good thing. Instead, these continued trends show that

workforce issues in the disability sector have become entrenched. Action on sector

reforms is urgently needed to address workforce challenges that have become a drag

on sector effectiveness.

Entrenched workforce issues threaten the NDIS

The latest NDS Workforce Census reveals concerning trends in the NDIS workforce,

characterised by staffing shortages and high turnover. This has serious implications for

the quality and sustainability of services for people with disability.

  • Overreliance on casual staff: A significant portion of the workforce (37 per

    cent) are casual support workers with high turnover rates. This creates instability

    within the system and hinders the building of long-term relationships with

    participants.

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  • Escalating turnover: Both casual and permanent staff turnover rates are on the

     rise, reaching 24 per cent and 16 per cent respectively. This annual churn of
    
    nearly 16,500 employees disrupts service continuity and creates a constant need
    
     for recruitment and onboarding, which is a costly process.
    

Financial viability crisis looms

The workforce challenges translate into a financial viability crisis for many NDIS

providers. Inadequate pricing, rising operational costs and high staff turnover create a

perfect storm, threatening service sustainability:

  • Losses and break-even operations: A significant number of providers (52 per

    cent) reported operating at a loss or barely breaking even in FY 2022–23.

  • Delivery concerns: Due to workforce issues, almost 70 per cent of providers

    express concerns about maintaining service provision at current funding levels.

  • Hidden costs of turnover: Estimates suggest providers incur over $80 million

    annually in invisible costs solely due to staff turnover (including recruitment,

    onboarding and lost productivity).

In the recent NDIS Review Report, ‘Working together to deliver the NDIS’, the

Australian Services Union has estimated that it can cost between $2130 and $3320 to

on-board a new staff member. Using the lower end of this estimate, this represents a

potential invisible cost of $40.5 million across the 361 organisations responding to this

year’s census. Even when excluding casual staff members, the costs still equate to

over $17 million. Using estimates of the 2022 workforce numbers, this would represent

a cost to the overall NDIS service ecosystem in the range of $80 to $190 million per

year.

The NDIS Workforce Census serves as a wake-up call. Urgent action on workforce

challenges is needed to ensure a sustainable and high-quality NDIS for all participants.

5.0 The importance of market stewardship in the NDIS

The crucial role of NDIA market stewardship in the NDIS

The role of the National Disability Insurance Agency (NDIA) as a market steward is

essential for the NDIS’s success across all stages. It acts as a guiding force for

implementation, performance, governance, administration and expenditure.

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Benefits across the NDIS lifecycle

  • Implementation: Market stewardship ensures a vibrant network of service

    providers, preventing service gaps and catering to diverse needs.

  • Performance: It incentivises high-quality services through clear standards,

    monitoring systems and rewards for exceptional outcomes. This fosters

    innovation and efficiency.

  • Governance: Market stewardship promotes transparency and accountability by

    establishing clear pricing structures, data collection and diverse provider options,

    empowering participants with informed choices.

  • Administration: It creates a smoother experience for everyone, with clear

    regulations, established networks and streamlined processes, reducing

    administrative burdens and costs. Additionally, it allows for adaptation to

    evolving needs and technologies.

  • Expenditure: Market stewardship promotes responsible use of funds by

    incentivising efficient service delivery, discouraging monopolies, and

    encouraging investments that demonstrably improve participant outcomes. This

    helps maintain service quality while controlling costs, ensuring the NDIS’s long-

    term financial sustainability.

In essence, effective market stewardship is the invisible hand that shapes the NDIS into

a program that delivers quality services efficiently and sustainably for all participants.

A well-functioning NDIS market, fostered through effective stewardship, contributes to

four key goals:

  • Informed participant choice and control: Participants deserve clear

    information about available service offerings. This empowers them to make

    informed decisions about their NDIS supports, selecting services that best meet

    their individual needs and goals.

  • High-quality services and improved participant outcomes: Effective market

    stewardship incentivises providers to deliver high-quality services that are

    evidence-based and demonstrably improve participant outcomes. This requires a

    workforce with the necessary skills, experience and qualifications. A sustainable

    disability sector, supported by fair pricing structures, allows providers to invest in

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staff training, professional development and innovative service models that

  optimise participant well-being and independence.
  • A sustainable workforce and flourishing disability sector: A thriving NDIS

    market fosters a robust and sustainable workforce within the disability sector. It

 needs fair wages, attractive career pathways and strong professional
  development opportunities. A well-managed market incentivises investment in

    staff, leading to higher retention rates, improved morale and, ultimately, better

   quality care for participants. Furthermore, a flourishing disability sector fosters

   innovation and attracts new entrants with fresh ideas and approaches to

    disability support.
  • Accessibility for all participants and safeguarding of rights: All NDIS

    participants, regardless of location, disability type or background, deserve

    equitable access to a diverse range of quality support options. Effective market

    stewardship ensures that services are geographically accessible and cater to a

    wide range of needs. It also prioritises participant safety and well-being through

    robust safeguards that protect participants from exploitation and ensure service

    providers adhere to ethical and professional standards.

The current NDIS market faces challenges that hinder its ability to fully achieve these

goals. Two notable hurdles include:

  • Workforce shortages and low wages: The disability support sector struggles

    with workforce shortages and low wages. This can have a significant impact on

    the quality and sustainability of services. Low wages make it difficult to attract

 and retain qualified staff, leading to high staff turnover and potentially
  compromising the quality of care participants receive.
  • Pricing structure that discourages investment: The price regulation system

    does not adequately reflect the true cost of delivering high-quality services. This

    can disincentivise providers from investing in innovation, staff training and

    service excellence. If price caps are set too low, providers may struggle to cover

    the costs associated with employing, training and retaining a qualified workforce.

    This can lead to a race to the bottom, where providers prioritise cost-cutting

 measures over quality investments.

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Effective market stewardship holds the potential to address these challenges cultivate a

vibrant NDIS market that empowers participants with informed choice, high-quality

services and support a flourishing disability sector that prioritises their well-being and

independence.

Conflict of Interest: Setting fair prices while containing Scheme costs

The NDIA’s role in the NDIS market presents a potential conflict of interest that hinders

effective market stewardship. This conflict arises from the NDIA’s dual responsibility:

1. **Budget management:** The NDIA sets the overall budget for the NDIS, aiming to

  ensure its long-term financial sustainability.

2. **Market stewardship:** The NDIA oversees the functioning of the NDIS market,

  aiming to foster competition, service quality and participant choice.

This duality can create a conflict in the following ways:

  • Price setting and budgetary pressure: The NDIA sets price caps for NDIS

    services. If the NDIA prioritises budget control, they might set price caps that are

    too low to incentivise high-quality providers to enter or remain in the market. This

    could lead to a race to the bottom, where providers prioritise cost-cutting over

    service excellence.

  • Data bias: Metrics used to assess market health, such as provider payment

    activity, might be heavily influenced by the NDIA’s own budget framework. This

    could lead to a situation where the NDIA prioritises metrics that reflect a low-cost

    market, even if it comes at the expense of participant well-being and service

    quality.

  • Limited incentives for innovation: With a focus on financial sustainability, the

 NDIA might be less likely to support innovative service models or price structures
   that could benefit participants in the long run, even if these models require

   upfront investments.

Participants ultimately bear the brunt of the NDIA’s potential conflict of interest. Tight

budget controls might lead to lower price caps, discouraging investment in qualified

staff and ultimately reducing service quality. Additionally, there is limited choice if price

caps restrict new providers from entering the market. This can leave participants with

fewer options and limited access to specialised services. Most importantly, a perception

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that the NDIA prioritises finances over participant well-being can erode trust in the

entire NDIS system.

Business dynamism: A sign of a healthy market?

As discussed previously, effective market stewardship is essential for the NDIS to

achieve its goals. While the NDIA has undertaken efforts to regulate the market,

challenges persist. This section delves into one of the NDIA’s measures of market

health: business dynamism of registered providers. While valuable, this metric has

limitations in fully capturing the market’s condition.

Key metrics from the 2023–24 Annual Pricing Review report include:

  • High continuity among key providers

    • A significant portion (38 per cent) of registered providers have consistently
    received payments over a three-year period, indicating market stability.
    
    • These consistent providers account for a substantial share (75 per cent) of

      total payments, suggesting they are crucial players in the market.

    • This high continuity allows the NDIA to focus on established providers with a

    proven track record, simplifying market oversight.

  • Shift towards larger providers

    • The data shows a trend towards registered providers serving more

      participants.

    • This suggests a consolidation in the market, with a smaller number of

    providers.
    
    • The NDIA needs to ensure larger providers maintain quality service delivery
    while managing a larger client base.
    
    • This might require the NDIA to implement regulations or incentives that encourage quality care despite growth.
  • Limited provider exit

    • The rate of inactive providers claiming zero DSW payments suggests many

      “exit” from the DSW market altogether, rather than just offering other NDIS

    services.
    

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  • Low exit rate (0.2%) indicates a relatively stable market composition, which

     can be positive for continuity of care.
    
     *  While stability is good, the NDIA should monitor if this low exit rate hinders
    
    new provider entry or market innovation.
    
     *  The NDIA might need to explore reasons for provider exits to understand if
    
     any market barriers exist.
    
    • Focus on smaller providers

      • The data reveals a significant number of inactive providers previously
      received low DSW payments (under $10,000 per half-year).
      
      • This suggests smaller providers might struggle to compete or find

        sustainability in the market.

      • The NDIA needs to consider policies that support smaller providers,

      especially those serving niche needs or regional areas.
      
      • This could involve exploring alternative funding models or simplifying
      administrative processes for smaller providers.
      

Business dynamism data, though informative, offers a limited view of NDIS market

health. It tracks provider activity through payments, not service quality, and focuses on

overall market exits, missing struggles within specific service categories. New entrants

might not represent innovation, and established providers might innovate without

frequent market churn. Additionally, national data can mask regional issues with

provider availability or competition. For effective market stewardship, the NDIA needs a

more comprehensive approach.

6.0 Strategic pricing for a sustainable NDIS

The NDIS aims to empower participants through a market-driven approach. However,

ensuring a well-functioning market requires effective stewardship by the NDIA. This

section will delve into key areas where the current approach to market stewardship

presents challenges and opportunities for improvement.

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Pricing and its impact on the market

The current approach to market stewardship in the NDIS, which relies heavily on fixed

price caps, faces some limitations. These limitations hinder the overall effectiveness of

the market in providing quality services for participants.

  • Limited choice and competition: Price caps discourage new providers from

    entering the market or from delivering certain types of supports, to certain

    participant cohorts or geographic locations. This reduces the diversity of service

    options available to participants.

  • Disincentivising quality: The system does not adequately reward providers

 who invest in quality improvements and deliver services that maximise
   participant outcomes.
  • Incomplete cost picture: The pricing model does not fully consider the true cost

    of providing high-quality support services. This includes factors like attracting,

    training and retaining qualified staff.

  • Inadequate recognition of complexity: The pricing structure fails to adequately

    recognise the additional costs of supporting participants with high and complex

    needs. This can lead to a situation where providers are unable to deliver

    essential services due to financial constraints.

2023–24 Annual Pricing Review

The NDIS Annual Pricing Review is a critical exercise undertaken by the National

Disability Insurance Agency (NDIA) to ensure that the pricing structure of the NDIS

remains fair and sustainable, balancing the needs of participants, service providers and

the overall scheme’s financial health.

NDS’s submission to the 2023–24 Annual Price Review (APR) outlined a clear

roadmap for a sustainable NDIS, prioritising quality service provision. The submission

described a disability sector at breaking point.

Providers are reporting their worst financial year ever. More organisations are running a

deficit and far fewer are breaking even. Financial reserves, often built up over decades

with the support of local communities, dwindle as providers struggle to make ends

meet. More providers are concerned that they will not be able to provide support at

current NDIS prices.

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However, the NDIA’s final decisions fell short, raising serious concerns about the future

of the scheme.

The NDIA 2023–24 Annual Pricing Review report notes the following:

    *  **Market growth and challenges**

        *  The NDIS market is experiencing significant growth, with both registered

       and unregistered providers seeing increases in numbers and claim

        amounts. This indicates a market that is adapting to meet rising demand.

        *  However, a potential concern arises from the decline in registered

         providers despite their increased claim amounts. This suggests a shift

        towards unregistered providers, which may raise questions about quality

          control and consistency.

    * **DSW Cost Model Scrutiny**

        *  The DSW Cost Model, used to set price limits for DSW services, faces

           criticism for potentially underestimating provider costs. Stakeholders point

          to factors like underestimated corporate overheads, lack of differentiation

           for complex needs, and setting efficiency levels that may not reflect

         current market realities.

        *   In response, the NDIA seeks to improve the model by incorporating data

        from recent surveys and mandated reporting from not-for-profit

         organisations. However, challenges remain in accurately capturing costs

        across diverse provider structures and differentiating NDIS-specific

            activities from broader organisational functions.

    *  **NDIS pricing reform on the horizon**

        *  The Australian Government acknowledges the need for reform in NDIS

          pricing structures. This aligns with initiatives like the Department of Social

         Services' Pricing and Payments Framework and the Independent Health

       and Aged Care Pricing Authority's (IHACPA) planned work for 2024–25.

       These initiatives aim to improve efficiency, effectiveness and data-driven

         decision-making.

    *  **Support coordination in flux**

        *  The NDIS Review highlighted inconsistencies in support coordination

          delivery. While the number of providers, particularly Level 2 providers, has

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significantly increased, there are concerns with cost pressures and

         maintaining service quality under the current financial model.

        *  Acknowledging the upcoming reforms proposed by the NDIS Review, the

          report advises against developing a specific cost model for support

         coordination at this time. This aims to minimise disruption during the

           transition to a potentially revamped intermediary service structure.

Despite the number of submissions received from providers and peak bodies and the

presentation of independent benchmarking data, the APR failed to understand the

needs of the sector:

  • Financial stability: Our submission highlighted the financial crisis gripping

    providers. Many reported their worst year ever, with deficits rising and reserves

    dwindling. Despite acknowledging the need to address these issues, the NDIA’s

    response lacked the urgency required.

  • Quality over quantity: We emphasised the importance of pricing that

    incentivises quality care. This includes fair wages, staff development and robust

    quality assurance measures. Unfortunately, the NDIA’s approach prioritises

    quantity of services over the quality of services delivered.

  • Cost-reflective pricing: NDS proposed adjustments to reflect rising costs

    across the board, including CPI, wages and overhead expenses. The NDIA’s

    minimal price increases fail to cover these rising costs, putting further strain on

    providers.

The results of the recent pricing review are a missed opportunity to invest in a

sustainable disability support sector:

  • Limited price increases: NDS called for full CPI and WPI adjustments, but the
 NDIA only implemented a partial increase. This leaves providers struggling with
    inflation and rising wages.
  • Rejection of quality incentives: NDS proposed supplements for registered and

    intermediary providers to incentivise high standards. The NDIA’s rejection of

    these proposals sends a worrying message about their commitment to quality.

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  • Stagnant pricing for crucial services: The freeze on prices for therapy, plan

    management and support coordination creates a funding gap, jeopardising

    access to these vital services for participants with complex needs.

This inadequate funding ultimately results in:

  • Loss of quality providers: High-quality providers, unable to absorb rising costs,
 may be forced to leave the NDIS. This creates a double whammy for participants

— reduced access to essential services and a potential increase in unregulated

   or unqualified providers.
  • Deterioration in service quality: Without proper funding, service quality

    inevitably suffers. This jeopardises participant safety and well-being, the very

    foundation of the NDIS.

Annual Price Review Pulse Survey shows most providers reconsidering their

futures

Following the release of the APR, NDS conducted a Pulse Survey to assess the impact

that the decision would have on providers and the participants that they support. The

Pulse Survey revealed a shift in thinking — from finding ways to cut budgets without

cutting corners to seriously considering cutting services entirely.

Unhappiness and anger over pricing was unmistakable in many responses: “The NDIS

price system is a cruel joke that is putting the most vulnerable at the most risk and

slow[ly] crushing the quality providers to death” [multi-state provider].

The survey drew responses from small to large operators from every state. Of the 1258

responses to the question, Are you actively reconsidering your organisation’s future as a result of the new price limits? 84 per cent (1062) said yes and just 10 per

cent said no.

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Are you actively reconsidering your organisation’s
future as a result of the new price limits?
(Chart visual showing 84% Yes, 10% No, 6% Don’t know)

Are you actively reconsidering your organisation’s future as a result of the new price limits? Number Per cent
Yes 1,062 84 per cent
No 124 10 per cent
Don’t know 72 6 per cent
Total 1,258 100 per cent

The second question dealt more directly with service delivery: Are you considering stopping some or all of your disability services as a result of the new price limits? Three-quarters of respondents said that they were thinking about cutting services, 14 per cent said they didn’t know, and just ten percent said no.

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Are you considering stopping some or all of your
disability services as a result of the new price limits?
(Chart visual showing 75% Yes, 11% No, 14% Don’t know)

Are you considering stopping some or all of your disability services as a result of the new price limits? Number Per cent
Yes 940 75 per cent
No 137 11 per cent
Don’t know 181 14 per cent
Total 1,258 100 per cent

The third question asked those who are considering cuts to services for more detail

about the types of services they might cut, when they might cut them, the effects of

their cuts to regional and remote services, and how many participants might be

affected.

Their responses gave a complex picture of service delivery, with financial and other

pressures coming from all sides and a range of strategies under consideration for

survival.

For one WA provider, the APR decision was just one more reason to stop supporting

NDIS participants altogether, citing “lack of clarity, additional time requirements, no

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stable supports, poor NDIS staff training, payment limits below other funding … and the

seemingly very dodgy push to move to large providers…”

For most providers, costs rising faster than prices is the crucial issue. One Victorian

organisation claiming a loss of $870,000 in the last financial year, said that price

increases did not cover the 1 July wage increases for long-term staff, “without

beginning to consider insurance, energy bills, Workcover, etc … If we don’t turn things

around in the next 12 months, we will likely close before end of FY24–25…”

One regional NSW provider, who is considering its options, admits that closing its doors

is one of them: “This [would] impact significantly not only [our] participants and their

families but also the staff that would be out of a job.”

As we have seen in previous surveys, unrealistic pricing unfairly affects registered

providers, who have extra compliance costs: “I am being forced to de-register my

business as I can no longer afford the costs associated with this expense.” [Vic.

provider].

In the past, many organisations have cross-subsidised services, moving funds from one

area with profits to NDIS services that are making a loss. The survey shows that

financial juggling of this type has reached its limit: “While in previous years the slight

margin we receive through SIL was able to subsidise other services, this year shrinking

funding has meant we can no longer rely on this” [NSW provider].

As narrow margins turn into losses, providers look to cut travel to support participants:

“Will no longer travel further than what is billable. Used to absorb this expense” [SA

provider]. Many rightly pointed out that limiting travel will hit regional and remote

services most.

Another solution being considered is downsizing — “To save the business [we] will

need to reconsider size of business, moving to smaller premises” [Qld provider]. Laying

off staff is now an option for many organisations: “[We] will need to reduce hours for all

staff, if not make them redundant, with no price increase for capacity-building supports”

[NSW provider].

Other providers are moving their businesses away from disability to aged care, where

“[t]he wages are higher so it’s easier to attract staff, pricing is higher, and the margins

are better. And there is less red tape and less likelihood of unreasonable fines being

imposed” [Multi-state provider].

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Responses indicated that those participants at gravest risk of cuts include those

needing the most support. One NSW provider will be telling participants who depend on

complex, high-intensity supports that they will soon “cease any unfunded supports …

reduce unfunded nursing support, reduce ratios in SIL that have previously been

covered and now not funded in plans, [and may make] … changes to staffing (use of

agency, etc.).”

For participants with complex behaviours, the pricing does not recognise the specialist

skills to support them: “Given the inability to claim high-intensity support for participants

with complex behaviours, we will be looking to cease servicing these existing

participants and refusing to accept new participants with complex behaviours” [Tas.

provider].

And participants in regional, remote and rural areas will feel the brunt of withdrawn

services: “65 [per cent] of our clients are rural and remote. If we close our doors there

aren’t any other local providers to fill the gap. [Six] years of price freeze, with current

inflation, is killing us” [SA provider].

Many providers, however, are determined to keep providing high-quality services, even

if it means losses. While this approach is admirable and in keeping with the ethos of the

sector, it is not sustainable.

7.0 Recommendations for a better NDIS market

Stewardship

The NDIS Review: A call for reform

The NDIS Review has been clear: the Australian Government needs to clarify the roles

of relevant agencies for administration market stewardship, pricing, policy, regulation,

commissioning and legislation.

The NDIS Review identified limitations in the current approach to market stewardship,

particularly price caps. Analysing the Review’s recommendations on pricing reform can

provide valuable insights.

Key considerations

  • Exploring alternative pricing models: The Review might suggest exploring alternative pricing models that move beyond fixed price caps.

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  • Focus on quality and innovation: The Review likely emphasises the need for pricing models that incentivise quality care and foster innovation in service delivery.

The NDIS Review Panel envisions a more active role for governments in overseeing

the NDIS market. This means governments should act as stewards to ensure the

market functions effectively and benefits everyone.

The Panel acknowledges that different government agencies have varying roles in

market stewardship. While the Department of Social Services sets market policy, other

agencies like the NDIA and the Quality and Safeguards Commission play a role in:

  • providing information and guidance to market participants
  • implementing NDIS policy
  • monitoring the market’s performance
  • acting when the market malfunctions.

The NDIS Review proposes a comprehensive approach to address shortcomings in the

market, with a focus on reforming pricing and payment structures to incentivise quality

service delivery. The key recommendation is **Recommendation 11: Reform pricing

and payments frameworks to improve incentives for providers to deliver quality

supports to participants**. This recommendation includes several action items:

  • Action 11.1: The Department of Social Services should develop a new NDIS pricing and payments framework, administered by the National Disability Insurance Agency and the Independent Health and Aged Care Pricing Authority. This framework should include better ways to pay providers, promoting efficient and high-quality supports with a focus on continuity of supply.
  • Action 11.2: The National Disability Insurance Agency should progressively implement preferred provider arrangements for capital supports. This leverages the government’s buying power and streamlines access for participants.
  • Action 11.3: The Australian Government should transition responsibility for advising on NDIS pricing to the Independent Health and Aged Care Pricing Authority (IHACPA). This strengthens transparency, predictability, and alignment with best practices in other sectors.

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  • Action 11.4: The Australian Government should continually review and refine the pricing and payments framework as market conditions evolve, ensuring its effectiveness in a dynamic environment.

By implementing these recommendations, the NDIS can create a market that

incentivises quality care, fosters sustainability and delivers better outcomes for all

participants.

The way forward

Systemic reform and investment are essential. The current system is demonstrably

unsustainable. NDS calls for a multi-pronged approach involving sector-wide reform

and supportive measures:

  • Pricing reform: NDIS pricing needs a significant overhaul to reflect the true cost of delivering quality services, especially for providers supporting participants with complex needs.
  • Workforce investment: Training, supervision and retention strategies for highly skilled practitioners are crucial but currently underfunded.
  • Market monitoring and intervention for sustainability: NDS advocates for government support over the next five years to transform the NDIS sector and fosters a market that delivers quality care, offers choices and remains sustainable.

Pricing reform: Ensuring transparency and sustainability

**Recommendation: Establish an Independent Pricing Authority in alignment with

NDIS Review findings**

The NDIS Review highlighted the need for a reformed pricing framework to incentivise

quality care and ensure a sustainable NDIS market. This recommendation directly

addresses these concerns by transitioning the responsibility for advising on NDIS

pricing to the Independent Health and Aged Care Pricing Authority (IHACPA) echoing

Action 11.3 of the NDIS Review.

Why an Independent Pricing Authority?

  • Transparency and objectivity: IHACPA, independent of the NDIA’s budget pressures, would set prices based on objective data. This includes the true cost

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of delivering high-quality services (staff wages, training, quality assurance) and

regional variations. This transparency fosters trust within the NDIS market.

  • Fairness and predictability: IHACPA would ensure fair and predictable pricing for providers, eliminating the potential for underfunding of quality services. This allows providers to invest in their workforce and resources, ultimately benefiting participants.
  • Alignment with best practices: Like models in healthcare and aged care, an IHACPA aligns with best practices for price setting in social service sectors. This fosters a more efficient and sustainable market.
  • Focus on quality and efficiency: IHACPA can consider factors beyond just cost, such as quality benchmarks and service efficiency. This incentivises providers to invest in staff training, quality assurance measures and innovative practices that improve participant outcomes.

The case for urgent change

The NDIS Review emphasises the need for immediate action. While the establishment

of an independent pricing mechanism may take time, the NDIS can implement interim

measures to ensure fairer pricing and incentivise quality care. These could include:

  • Cost modelling transparency: Increase transparency in the NDIS cost modelling process, allowing providers to better understand how prices are set.
  • Piloting outcome-based funding models: Explore pilot programs that reward providers for achieving positive participant outcomes, not just service delivery.
  • Upfront payments for providers: Consider implementing upfront payments for providers, based on participant plans, to improve cash flow and reduce financial strain.

**Recommendation: Implement a cost-reflective pricing model within the new NDIS

Pricing and payments framework (as outlined in Action 11.1 of the NDIS Review)**

This framework, co-administered by the NDIA and IHACPA, should incentivise

providers to deliver high-quality supports to participants.

The pricing system often fails to account for the full cost of delivering quality care. This

financial strain on providers can lead to:

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  • Staff shortages: Difficulty attracting and retaining qualified staff due to under- competitive wages.
  • Reduced training: Lowered investment in staff development, potentially impacting service quality.
  • Compromised service quality: Limited resources lead to a decline in service delivery standards.

Adopting a cost-reflective pricing model achieves a trifecta of benefits. Firstly, financial

stability for providers allows them to invest in their staff, resources and quality

assurance measures. This creates a sustainable market environment where providers

can deliver high-quality services consistently.

Secondly, competitive pricing attracts and retains reputable providers, fostering a wider

range of service options for participants.

Finally, a financially healthy network of providers able to achieve efficiency over time

ensures the long-term viability of the NDIS scheme itself, benefiting participants for

years to come.

Recommendation: Implement a registration supplement for NDIS Providers

Underfunded NDIS pricing creates a vicious cycle. Providers struggle financially,

leading to staff shortages and reduced training. This ultimately results in compromised

service quality for participants who rely on the NDIS.

To address financial strain on NDIS providers, a registration supplement is proposed.

This fixed percentage increase on claims would be paid directly to providers, boosting

their finances without impacting participant plans. Two payment methods are

suggested: providers claiming based on verified claims or an automated NDIA system.

The supplement percentage needs careful analysis to avoid unintended consequences.

A sunset clause could be implemented for review after a set period.

Benefits of the supplement include:

  • improved provider sustainability allowing investment in staff, training, and quality assurance
  • enhanced market attractiveness attracting more providers and potentially driving innovation
  • NDIS market stability fostering a healthy environment for participants.

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This proposal is one piece of a broader reform picture, alongside cost-reflective pricing

and an independent pricing authority, for a sustainable NDIS market.

Workforce investment: Fostering a skilled workforce

Recommendation: Funding for strategic workforce development and retention

Attracting and retaining disability sector workers with the right values and skills remains

an issue. The demand across the care and support sectors will only increase, while

wages and conditions reflect the low value that the community places on these careers.

Current NDIS pricing does not support investment in training, support and supervision.

The NDIS Review underscored the pressing need to address the significant workforce

shortages in the disability sector. It remains one of the fastest growing workforces in

Australia. Within the next three years, it is estimated that another 128,000 workers (or a

40 per cent increase in workforce size) will be required to meet NDIS demand. This

challenge is compounded by high turnover rates, which see many workers leave the

sector each year. It is expected that the disability sector will lose between 198,000 to

292,000 workers by 2025.

NDS strongly supports an integrated approach to develop the workforce of the care and

support economy, using sector-specific strategies for guidance and to add nuance to

this. Although the aged care and early childhood sectors have well-established

workforce strategies supported by government, the disability sector is at the start of the

journey to developing a NDIS Workforce Strategy.

There is an opportunity to leverage work being undertaken to develop the National Care

and Support Economy Strategy to co-design, fund and implement a disability workforce

strategy. This strategy should consider mechanisms to fund training and worker support

that is responsive to individual participant and worker needs, the provider context and

the place where support is being delivered.

Strengthening market monitoring and intervention for NDIS sustainability

Recommendation: Establish a sector-led reform implementation taskforce

Convene a group of stakeholders, including people with disability, advocacy

organisations, unions, service providers, and experts, to advise the NDIA on market

monitoring and intervention strategies.

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**Recommendation: Develop a collaborative five-year NDIS implementation

roadmap**

This recommendation proposes collaborating with the NDIS Taskforce to create a

public five-year implementation roadmap for the NDIS reforms. This roadmap should be

data-driven and prioritise the following key elements:

  • Monitoring and evaluation: Establish a framework for ongoing data collection and analysis to track progress towards achieving NDIS goals.
  • Early intervention strategies: Develop and implement strategies for early identification of needs and proactive intervention to improve participant outcomes.
  • Targeted interventions: Address service gaps and quality issues through targeted interventions based on identified needs and data insights.
  • Promoting provider diversity: Foster a diverse range of service providers within the NDIS to ensure participants have access to a wider selection of high- quality options.
  • Sequencing of reforms: Clearly outline the sequence of NDIS reforms over five years to ensure a smooth and strategic transition.
  • Stakeholder consultation: Prioritise ongoing engagement with stakeholders, including participants, families, providers, and the community, throughout the implementation process.
  • Minimising disruptions: Mitigate potential disruption to participants and providers by communicating changes effectively and providing necessary support during the transition period.

Recommendation: Create an industry transformation fund

Establish a fund to support structural adjustments required for a sustainable market,

prioritising workforce development, infrastructure investments for service providers and

innovation in service delivery models.

**Recommendation: Develop a comprehensive implementation plan for a risk-

proportionate regulatory framework**

Establish a new NDIS regulatory framework with a detailed implementation plan that

includes clear timelines, responsibilities and milestones. This plan should focus on:

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  • defining risk-based regulations and factors promoting quality services
  • implementing a universal provider registration process with varying categories based on risk
  • conducting thorough suitability assessments for providers
  • establishing ongoing monitoring, support and compliance mechanisms for all providers
  • regularly reviewing the framework’s effectiveness and making adjustments.

Recommendation: Enhance initiatives to empower participants

Invest in programs that build consumer and community capacity. Provide ongoing

support and training to equip participants with the knowledge and skills to navigate the

NDIS marketplace and make informed choices about their plans.

8.0 Conclusion

The NDIS has the potential to be a beacon of hope and empowerment for people with

disability. However, the market dysfunction threatens to undermine this potential.

Achieving the reform agenda will require structural adjustment across most aspects of

service delivery. Careful deliberation, collaboration and co-design will be necessary to

implement its recommendations effectively. Providers need a seat-at-the-table to

ensure changes can be safely and practically implemented and all stakeholders must

work together to ensure high-quality, equitable and sustainable supports that provide

choice, control and independence to people with disability.

Effective market stewardship by government, the NDIA and the NDIS Commission is

central to the success of the NDIS. By implementing the recommendations outlined

above, a thriving NDIS market that empowers participants, strengthens the disability

sector and delivers high-quality, impactful supports can be cultivated. This, in turn, will

enable participants to live more independent and fulfilling lives.

The NDIS Review offers a clear roadmap for reform, with the establishment of an

independent pricing body as a critical first step. By implementing these

recommendations, we can ensure the NDIS delivers on its core promise: quality care,

security, and choice for all participants. The time for decisive action is now. We cannot

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afford to wait and watch as the NDIS market crumbles, failing the very people it was

designed to support.

Contact

Laurie Leigh

CEO

National Disability Services

NDS website

Friday, 12 July 2024

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